Ntombizodwa Ndlovu 1 , Eustasius Musenge 1 , Sung Kyun Park 2 , Brendan Girdler-Brown 3 , Guy Richards 4 , Jill Murray 1,5 Show Affiliations »
Abstract
OBJECTIVE: We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners. METHODS: Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975-1989), rapid HIV spread (1990-2004) and antiretroviral therapy (2005-2014) periods. RESULTS: The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission). CONCLUSIONS: Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
OBJECTIVE: We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners . METHODS: Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death . Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death , gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975-1989), rapid HIV spread (1990-2004) and antiretroviral therapy (2005-2014) periods. RESULTS: The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners , and from 2.07% to 5.19% in white miners , with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis , increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission). CONCLUSIONS: Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction , together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis . © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Entities: Chemical
Disease
Species
Keywords:
HIV; autopsy; compensation; pathaut; silicosis
Mesh： See more »
Year: 2018
PMID： 29934377 DOI： 10.1136/oemed-2017-104806
Source DB: PubMed Journal: Occup Environ Med ISSN： 1351-0711 Impact factor: 4.402